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Migrainous Infarction

Migrainous Infarction (Stroke During a Migraine Attack)

Migrainous infarction refers to a stroke occurring during a migraine attack, usually in conjunction with aura. This rare complication is more common in younger women and individuals with other vascular risk factors, such as smoking or oral contraceptive use. Symptoms can include weakness, numbness, or speech difficulties, and it requires immediate medical attention to minimize long-term damage.

Patients diagnosed with migrainous infarction are typically younger (average age 29-39 in case series), have fewer traditional vascular risk factors, and have more favorable prognosis compared to strokes from traditional risk factors.

Migrainous infarction is a rare but serious complication of migraine, defined as a stroke that occurs during a migraine attack with aura. The annual incidence of migrainous infarction has been reported to be 0.80/100,000 per year. It most commonly affects younger women (average age 29-39 in case series), particularly those with additional vascular risk factors such as smoking, high blood pressure, or the use of estrogen-based contraceptives. Recognizing and addressing risk factors is essential to minimize the likelihood of this condition.

During migrainous infarction, the aura phase of the migraine does not resolve, and brain imaging (e.g., CT or MRI) confirms ischemic changes in the affected region of the brain, which occur most commonly in the occipital-parietal region of the brain. Symptoms of migrainous infarction are often severe and can include:

  • Weakness or paralysis on one side of the body
  • Numbness or tingling
  • Difficulty speaking or understanding speech
  • Vision changes, such as loss of vision in one eye or visual field deficits

The pathophysiology of migrainous infarction is not entirely understood but may involve a combination of reduced blood flow due to cortical spreading depression and an underlying predisposition to vascular events. Immediate medical attention is critical for managing symptoms and preventing further damage. Treatment typically involves:

  • Acute stroke therapies, such as thrombolysis, if indicated and within the therapeutic window
  • Triptans and ergots should be avoided due to their vasoconstrictive properties
  • Secondary prevention strategies to reduce the risk of future strokes, including antiplatelet therapy and lifestyle modifications

Long-term management focuses on migraine prevention and controlling vascular risk factors. This might include:

  • Avoiding migraine triggers
  • Using preventive migraine medications, such as beta-blockers, calcium channel blockers, or anti-CGRP therapies
  • Managing comorbid conditions like hypertension or high cholesterol

Migrainous infarction is a reminder of the complex relationship between migraine and vascular health. Proactive management and prompt recognition of symptoms can help mitigate the risks associated with this rare complication.